Friday, November 16, 2012

Our VBAC Story ~~ Katie Angel

First Birth

With our first child, we were going to take the quickest birth class at the hospital to get it over with. All of the spots were filled, so we took a two-day birth class with the county and a newborn care class. After the class, although I was slightly less fearful, we felt so unprepared. The term "episiotomy" scared me even after I learned how to pronounce it. We found a 12 week series class, the Bradley Method of natural childbirth with an awesome and supportive instructor. We learned all the birth stages, I journaled my meals to get the optimal nutrition (eggs, natural vitamin C and lots of greens), and we learned all the risks and the benefits of the procedures and the drugs. We wrote our birth plan, we got all the baby gears ready, and we hired a doula to assist with the birth. We were as ready as we can be. Because it was our first birth, we decided to stay with the OBGYN group for a hospital birth and the closest hospital was 15 minutes away. It was the University Community Hospital, now the Florida Hospital. They were doctors commanding medical knowledge. We were open and went over our natural birth plan with all of the doctors. The doctor was okay with me drinking liquid at the hospital (who doesn't get thristy after a few hours of laboring). Like first time parent, we asked many questions, but one of the doctors didn't seem comfortable that we were asking many questions instead of just going along with whatever they're doing to us. That specific doctor didn't even know what is a double layer sutures as requested in our birth plan if we have to do a c-section. The doctor didn't like us wanting various birthing positions versus lying on my back. We realized that it may be an uphill battle at the hospital, but we were ready for whatever happens.

When the contraction started, first time parent mistake, in the beginning stage, we should've try to get some sleep instead of keeping track of the contractions throughout the night. It was just my husband and I. My contraction went on for two days before it was close enough for me to go to the hospital. Finally, this doula came over to our house right before we go to the hospital. We walked around and labored by the bed in my assigned room. The assigned nurse kept the hospital room dim and dark as requested in the birth plan. That OBGYN happened to be on call and he wasn't pleased that I didn't want to break my water and I didn't want to go along with a c-section only after four hours in the hospital. Even the nurse thought he was very rude to me. Although he approved of whole birth plan months before, when it was time, he said I wasn't allow to drink any liquid, only ice. Seems like bait and switch to me. It was diffcult to trust him. We were so glad we took the Bradley Method birth class. Because of our preparation, we know how to think for ourselves and how to make our decisions.

During contractions, a stranger male nurse came into the room to prepare some equipment and I was in the most vulnerable state, I felt alarmed. All those factors in this environment, I couldn't relax. My defense system was up. After that shift was over, another OBGYN came on duty. 12 hours at the hospital laboring, strong contractions without any progress, still at 6 cm! (but I guess depends on which doctor's hand you were talking about), I finally agreed to pitocin and I requested epidural to go along with that. I slepted and rested. Our baby's heart beat went down to dangerous level so the nurse had to turn down the pitocin. The OBGYN came in later and said because she was in the operation room doing a scheduled c-section, else they would've do an emergency c-section on us. Thank goodness she was busy then. The OBGYN was advocating a c-section since I was still at 6 cm instead of close to 10 cm, and for the safety of the baby. After almost three days of contractions, exhausted and I looked like a truck ran over me, in my mind c-section was the only way out, so I agreed to it. This doctor knew what is a double layer suture. The doula thought earlier the OBGYN said I was at 8 cm. It was a blur. The c-section happened so quick and we shed happy tears when we finally met Jasmine. Healthy 9 lbs 15 oz. January 2009 on the lunar day. The nurses there taught us first time parents how to take care of newborn. It was nice to have those extra hands. We asked for a lactation counselor whenever I needed help with latching or breastfeeding. Our county's baby cafe program or La Leche League would've offer similar or better breastfeeding support. I was supposed to eat soft food after a surgery, the hospital bought in a steak. I even mentioned to the nurse before that I'm a vegetarian. Good thing I wasn't hungary that first day and gave it to my husband to eat. My mom such an angel bought over home cooked meals. The hospital's bathroom was no Marriott. I thought it could have been cleaner. Also I spotted other people's blood stains in the birthing room. After we left the hospital, I had to continue to take pain medications. But right away, I developed really bad rash that I itched all over, my doctor told me to stop taking pain medications. At the hospital I was okay, my guess is that I was allergic to the generic pain medication. Between being in pain after a major surgery, still trying to learn to latch, taking care of a newborn, disappointment of a c-section, and the hormones, I was in a bad shape. I didn't get out much the first three months. I was either in pain from c-section or from latching. I almost gave up breastfeeding. Thankgoodness for La Leche League friends' support and my husband cheered me on to keep trying. Baby and I finally learned to latch properly.

Top Ten Signs Your Doctor Is Planning To Perform An Unnecessar​y Cesarean Section On You
by Jonathan Weinstein, MD, FACOG


Preparation for Second Birth

Raising a child took all of our energy, mentally and physically. Finally we were ready to give her a sibling when she was closer to two years old. That gave me time to heal. With our second baby, I knew I had to try vaginal birth after caesarean (VBAC). My recovery was too painful and I didn't want to go through it again. I wanted a better birth experience. Before we got pregnant, I went to see another OBGYN that came highly recommended. She was really nice and she had a good bedside manner. She said my muscle is too weak, I still leak urine easily with a sneeze. The baby was too big. Some people just not built to birth vaginally, small pelvic bone. etc. etc. etc. I researched and researched. I educated and empowered myself. I requested all of my and baby's medical records from the hospital and the OBGYN. Even though American Congress of Obstetricians and Gynecologists issued less restrictive VBAC guidelines, it's not easy to find an OBGYN that support VBAC. It was nearly impossible. OBGYN can bill and earn more with c-section. Scheduled c-section is quick, while labor is takes time and unpredictable in the busy schedule. It was hard to trust OBGYN's recommendations -is it better for the patients or does it makes the doctor's life easier. Trust issue always lingered in my mind. I didn’t want to hope to get the good OBGYN on call when I go into labor. Malpractice lawsuits loom over doctors and hospitals. Hospital's system has policies and guidance to minimize those risks and maximize revenue. If you want something different, their staffs are not trained to handle it. Not all the human being is built the same. Every body is different. I sought out anyone who had a VBAC. I attended events that's VBAC related. I joined a local ICAN (International Cesarean Awareness Network) support and facebook groups to find out who was able to have VBAC and how did they do it. I joined hypnobabies on-line discussion group. I talked to moms who had VBAC. I found youtube video clips made by moms who had VBA2C and even VBA3C. I was inspired by all of them. I saw the pattern, home VBAC with a midwife. Some people were able to have VBAC at the hospital, but some had to deal with obstacles. I had our local hospital experience and I knew what it was like. I needed to birth in various positions. I didn't like to birth under time pressure or restrictions. I know I needed positive energy and cheerleaders during contractions and in my most vulnerable position, instead of naysayers and doubters. They tell you, VBAC has a rupture risk. Labor and birth itself is a risk. C-section has a risk. Blood clot is one of the reasons. Epidural is not without risks. So in my mind, VBAC carries a risk like everything else, nothing more, nothing less. They scare you that you don't want to do VBAC.  

Home birth
I wasn't comfortable with home birth at first. But I talked with many women who had homebirth or at the birth center and heard about their experience. A mom who had the first child at a hospital, the second child at a birth center, and the third child at home, said the home birth experience was the best. Both of my grandmoms had eight children at home. They were able to do it. Generations and generations of human beings before them survived even when they were no hospital to birth in. My health was good. I was not a high risk patient. Less chance of me catching an infections or super bug at home than in the hospital. I can get home cook meals easier. I can see my oldest child whenever I like, visitation hour is anytime. Hospital has it's place. They can handle high risks patients, take care of NICU babies, and deal with emergency faster. Everyone has a reason for which path works for them.

Choosing My Team - After talking to many moms, I selected another doula and a midwife group that came highly recommended. I chose a birth team that supported me instead of doubted me. They did not disappoint. Before when I peed on the stick during checkups, the OBGYNs never said anything about the results. The midwife helped me to grow a healthy baby by letting me know if I had too much sugar or not enough of protein. I didn't know those information is available at each check up. The midwife spent time with me instead of rushing to the next patient. Not only physical state but also mental state for the well being. An OBGYN apologized to a staff that she took more than 15 minutes with me. With the midwife group, I received quality medical care that we wished all of the doctors would do with their patients. Since we took birth class a few years ago, we had to take a birthing class at the midwife's birth center for refresher. After all these birthing classes, we still learned so much from the birth center because they have so much experience with birth.
Before I was accepted, I had to go to an OB physician with hospital obstetrical privileges for the initial risk assessment. The doctor considered me a low risk maternity. Throughout my pregnancy, I was continuously monitored to see if I'm still a low risk pregnancy. Toward the end of my pregnancy, I had to get an ultrasound to check the thickness of my cervix. There are many checks along the way that can put me in the other category.

Contraction Strategies - I heard that water birth helps and eases the labor. So we reserved a water tub. It didn't do it for me and we had the water way too hot that I was passing out.  To help with pain management, we took a hypnobirth class with another awesome instructor. I listened to the CD almost everyday to calm me and bring me positive thoughts. When someone told me to call her when I'm screaming in pain, I didn't let that bother me. By listening to the CD, I brainwashed myself in a good way :) to think positive and to believe in myself. It's always good to think positive and believe in yourself :) I also listened to HypnoBabies tracks every night before I go to bed. One of the tracks really worked when I had the most intense contraction and I just closed my eyes and breathed through them. I heard from a mom that she welcomes the pain because that means the baby is on the way and she didn't have a chance to feel that the first time. Contractions are like menstrual period, just a little more intense :) Another pain management I used was to moan uninhibitedly. For me, it's easier not to care what others think or judge me while at home. Also, I was more relaxed at my own home, we have better control of who's coming into the house and the birth environment.

10 Pain Management Techniques for Natural Childbirth
http://www.theparentvortex.com/wordpress/10-pain-management-techniques-for-natural-childbirth/

Positive Energy

We didn't tell that many people that we're planning a homebirth. We did the research. It was our decision. We didn't want to debate with people why we responsible adults are deciding what's the best for us and our baby. We were ready to share the joy when the baby is here.

I read several books on natural birth to feel comfortable with natural birth. Ina Mays Guide to Childbirth and Dr. Sear's the Birth Book. To think positive, I was open to good birth stories. I avoided nightmare birthstories.






Mental Readiness 
Throughout the process, I kept going over and over in my head and wondered what went wrong the first time so we don't make the same mistake. I traced all of the steps and all of the decisions we made. I told my husband, this time around, I needed support for this and for that. We got mad at each other for what happened last time. We had to get over what happened in order to move on. It wasn't easy on our marriage but it had to be done and it was an important step to overcome. Hopes, fears, unresolved grief, self-doubts.

Baby Positioning 
Also this time, starting at the second trimester before the baby gets too big to move around, I did a lot of hands and knees on the ground (like a cat or a dog) to get the baby in the right position for easier birth. Anterior position rather than a posterior position or sunny side up. Since my toddler was making a mess on the floor after eating, I was on the floor cleaning everyday anyways. Also in this pregnancy, I was more active chasing my toddler instead of sitting on the couch watching TV. The baby was in the right position this time.

With my first pregnancy, I had an almost 10 lbs turkey. This time I went low carb all the way. I was afraid to eat any bread and rice. I ate a lot of fruits and vegetables. It wasn't easy in the beginning, but I got used to it.  Baby still ended up being 9 lbs, but I lost all the baby weight right away.

PUPPP

For me, as soon as I applied Palmer's stretch mark cream, pruritic urticarial papules and plaques of pregnancy (PUPPP) came out again, like my previous pregnancy. I immediately took dandelion root from GNC to decrease the itchness and it worked again. I must have a weak liver.

Homebirth Supply
We got the birth supply list. We got lots of disposal bed pads. I bought out all of my towels. We got paint tarp to cover the carpet by the birthing tub and under the bed sheet. Midwife came for a home visit.


Photo taken on July 4th at 2 p.m.

We didn't have a birth plan this time. We just went with the flow. With the first birth, I was trying to control it, and then lost it. This time, with experience under our belt, we were at peace with whatever is the outcome, knowing that we just have to go with the flow for birth.

My labor started on wee hours of the morning on July 4th - Independence Day. My doula came over and had me try various positions to see how the baby sits. My contraction stopped mid-day, so we decided to take a break and let it proceed naturally. I wasn't sure if I want a July 4th baby anyways :) After a night of crazy fireworks, my contractions started again on wee hours of the morning on July 5th. After bath, the contractions were still there. The contractions were getting intense. Between both pregnancies, the technology had advanced and we had the iPhone contraction timer app this time. Much easier than pen, paper and calculator. My husband has been texting my doula back and forth with contraction updates. When my doula arrived, she said my contractions were all over the place. My husband and I had no idea. My doula was definitely the professional here. Since I wasn't restricted in bed, I can move around and change positions, she saw how my belly sits. She thought about it last night and she had a theory. She had me wear a maternity belt to pull the baby closer, over my pelvic. My contractions were back to normal. I wondered if that was what was wrong with my first birth. My doula Stephanie was awesome. She has so much experience and training. She saved me from having another c-section. She has these credentials: Doctor of Naturopathic Medicine (NMD), licensed practical nurse (LPN), Certified Doulas (DONA). She knew which pressure point to press around midpoint of inner calf to get the labor going. Throughout the early contractions, we just hang out on the bed and watched romantic comedy movies on Lifetime TV. I haven't watched that much TV since my first child was born. LOL. We joked and laughed. We snacked, we ate, and we stay hydrated. My godsend mom was watching Jasmine for us. When the contractions started to get more intense, it was nice to get massages. My doula applied aromatherapy to take the edge off. Conair aromatherapy diffuser worked wonders. When the contractions got really intense, my doula showed my husband how to do pelvic squeeze properly and took off a lot of pain. Also I listened to my hypnobirth track and helped through some intense ones. It was nice to see that it worked.

By around 5-6 pm, Stephanie told me my baby will be here tonight. I couldn't believe it. I went through contractions with my previous birth, but I never know what transition was like. She contacted my midwife Bea and my birth photographer Nicole Gillette. My husband set up the water tub (make sure the new plastic tarp is in the tub before you add the water). The midwife broke my water. We got in the tub. But the water was too hot and we both got dizzy. When we moved to the room with the water tub, I lost the hypnobabies track and I couldn't get it to play on another device. So I sounded out with a deep and controlled moan for pain management. When baby's head was coming out, I pushed and pushed. I was exhausted. I pushed on my back leaning on my husband. I also tried squatting. I kept saying I can't do it. They kept cheering me and yelling me to push. I wished I ate more so I have more energy. We did the ring pull. They gave me Emergen C to drink to keep hydrated. They putted cold cloth over my forehead to keep comfortable. My doula gave me more aromatherapy scent to smell. My mom and Jasmine came back home, but Jasmine's screaming was distracting me, so they went back to the car and waited. I must have been pushing for an hour and I wasn't making any progress and getting tired and weak.


I heard many moms almost delivered on the toilet because it's a more natural way of pushing. I happened to find a chair with a hole and have it available just in case I need to use it. Actually the medical purpose chair was made for potty. It's very comfortable and sturdy. I moved to the chair and after only a few hard pushes, the baby was out. I couldn't believe it. I delivered a baby vaginally. During the transition, I was aware of my surrounding, but seems like I was also out of my body at the same time. Human brain is amazing to help you cope. For people who have fear of pain, yes, it was intense at that moment, but with all the support people, it's manageable and birth hormones help you forget about it. It was amazing to see Katie, to hold her, and to hear her cry. It was nice to have the photos and the video of her when she was born. I was kind of out of it and it's hard to remember all the details. It was a very special moment.


We tried to latch and nurse as soon as possible to get the natural oxytocin going to stop the bleeding. The baby was so alert. Very different from Jasmine (even with only an hour of epidural, Jasmine couldn't latch right away). I moved onto the bed. Katie nursed very strongly. She opened her eyes and looked at us. Just treasuring those moments. Jasmine wanted to meet her and she was so excited to finally see her little sister. My mom was so happy to hold Katie. Healthy 9 lbs. I had a big baby. Take that to whoever said I couldn't birth a big baby. So much for low carb diet, at least I didn't gain any weight after the baby was out. It was all baby. Both times I passed my glucose tolerance test. Someone said maybe I have a diabetic gene. Don't know if that did it. After the next few contractions, the placenta came out. I did have a third degree tear so I had to go to the hospital for suture. My doula went with me. I asked the doctor for lots of local anesthesia. To me, needles were more painful than contractions. I had a lot of gas from the pregnancy so it was embarrassing but luckily the doctor on duty was very kind.


When I was at the hospital, they tried to keep me there over night, but my baby was hungry at home. They did test my blood and said I had high white cell count and gave me the prescription for antibotics. I just gave birth to a baby for heaven's sake. I didn't want to deal with the side effects of the antibiotics like diarrhea when I'm trying to recover from giving birth to a baby, so I decided not to take it. A week or so later, I got another blood test and my cell count was normal and fine.

Before the midwife and her assistant left, they placed all of the used towels and bedsheet in the washer with oxiclean. Everything was cleaned.

Recovery was so much better this time around. I still had to recover. A baby came out of my vaginal. First week was the hardest, then it gets better day by day. I still had to lay in the bed and rest. For the first few weeks, I didn't have much muscle control down there. Depends diapers were the best. I had to sit gingerly the first two weeks on the poppy pillow because I didn't have a donuts pillow. It was easier to breastfeed without the c-section’s incision in the way. But by the end of the month, I was out and about, back to my normal self. So different from my previous experience. Following photo was taken 3 days after the VBAC.

Here are the photos from the first birth.  



Here are more photos from the VBAC.

Does it look like a different experience all together?  I was holding the baby :)




Believe

I think the toughest part of our VBAC journey was mental, because naysayers doubted me and I had to believe that I can do it. It was an empowering experience to say that I did it and others can do it too.

It was such a wonderful experience. Exactly how I want my birth to be. This personal choice was right of my family, my husband and I. We have Blue Cross Blue Shield of FL - PPO, and they covered my homebirth with the midwife. I didn't have any problem with the insurance at all since the labor center handled it. It was least of my worries.
At the end, I think we have taken all of the birth classes available out there :) So much for the quickest birth class :)

For moms who are trying a VBAC, know that you have the legal right to choose who you want to birth with, and don't be afraid to choose the one you think can provide the best care for you. It's so important to have choices on where you want to give birth. Seems like some lawmakers and its medical affiliates want to eliminate all competitions and monopolize the birth industry. It's difficult to find physicians who will sign off on a VBAC when hospital can blacklist them. There's plenty of business to go around.

Why did I go through all these?I didn't take the easier route.Later I found this in the NIH database during my research."Delivery by C-section has been associated with increased risk for allergy, diabetes and leukemia."Something about baby going through birth canal, effects body on the cellular level. "Research adds to evidence that babies born via C-section may miss out on beneficial bacteria passed on by their mothers."
http://www.usnews.com/science/articles/2010/06/22/babys-first-bacteria-depend-on-birth-route

Also, we went through all this so we can have a safer and healthier birth and baby. We knew c-section and epidural are not without risks. Up until birth, I tried to avoid all the negative energy and only surround with people with positive thinking. A huge part of VBAC is mental. Positive thinking. Believe in yourself and trust your body. You can do it. You're in good hands. Just go with the flow. Whatever happens you're okay with it. Positive imagery. Imagine you're holding a beautiful baby. Stay positive, look after yourself and believe you will achieve. YOU CAN DO IT!



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